Worker's Comp. No Fault & PIP Collector

Job Description

Job Description

Job Specific Competencies:

Performs billing functions to review and take necessary actions to resolve billing errors ensuring clean claim submission

Knowledge of insurance billing in the following areas: Workers’ Compensation and Motor Vehicle claims

Work directly with third party payers, internal and external customers, and other contract clients toward effective and efficient collection results on accounts assigned by management in accordance with departmental policy and procedures

Ability to work well independently and communicate efficiently and respectfully with patients and insurance representatives.

Must have experience with Workers compensation and No-Fault PIP in New York and New Jersey

Identify billing errors and denials, by understanding the problem and resubmit corrected claims or take other appropriate action to resolution.

Be able to negotiate settlements

Be able to communicate with law firms that are processing arbitrations on behalf of Hospital

Send appeals for: low reimbursement, no authorizations, timely filing, medical necessity etc. with correct documentation.

Submit paper claims to primary and secondary insurance with correct documentation, ie: operative reports, implant invoices, primary eob’s.

Adjust claims for correct fee schedule, incorrect payments and patient responsibility.

Scan work and correspondence daily and maintain clear detailed notes

Maintains a thorough knowledge of third party billing and collection requirements for payers assigned for handling.

Utilizes all resources available, including electronic inquires to verify eligibility, benefits and claim status

Exercises good judgment towards account resolution and documents all activity on account in a clear, accurate and consistent manner utilizing appropriate online system

Work correspondence, explanation of benefits and remittance advice daily ensuring a 72-hour turnaround period is met

Demonstrates excellent customer service skills when responding to incoming or outgoing calls in a most courteous manner providing clear and appropriate information as needed.

Demonstrates the ability to reconcile payments and contractual allowances when reviewing accounts in order to ensure the accuracy of the account balance

Resolves credit balances in accordance to departmental policy and procedure

Advise team lead and/or supervisor of any billing errors, payer trends in claims processing, denials or payment fluctuations, to ensure proper handling and escalation as necessary

Adhere to all Hospital Regulations associated with Compliance (to include HIPPAA etc.)

Is knowledgeable of and adheres to all hospital policies and procedures including but not limited to: Attendance Management: Reports to work on time; is flexible when staffing needs warrant change; requests time off in a timely manner; consistently utilizes time clocks to document in and out shifts. Rules of Conduct: Respects the rights and property of others; does not engage in Harassment or Violence in the Workplace. HIPPA: Maintains confidentiality of patients, staff and visitors at all times. Dress Code: Complies with dress code policy and wears ID at all times.

Successfully completed previous year’s goals or performance improvement plan.

Performs other duties as assigned.